32 Community Health & Care Support PATIENT SAFETY MONITOR Anaxsys Technology Ltd H " How do we know when a patient's clinical status is deteriorating?" This is an essential question to answer; the earlier healthcare professionals ( HCPs) identify a patient deteriorating and intervene the more likely that they will get a good outcome for the patient and possibly avoid costly intervention for the healthcare provider such as admission to an intensive care unit ( ICU) bed. There are calls by the National Institute for Health and Clinical Excellence ( NICE) and other bodies to increase the vital signs monitoring of patients, wherever possible. HCPs can now monitor a number of physiological variables on a continuous basis: blood pressure, temperature, arterial oxygen saturation and pulse rate. However, the physiological parameter that is most closely related to patient outcome is respiratory rate ( RR) and is the variable which still has no reliable means available to monitor continuously. Indeed, recent research has shown that nurses fail to measure RR 50% of the time. This is understandable; a nurse will need to observe a patient for one minute counting chest excursions that can sometimes be difficult to observe. In many clinical environments the need to provide an individual patient with intensive input occurs frequently, eg post- operative or casualty wards. It is clear from the literature and the company's own interviews with nurses that RR monitoring is frequently sacrificed. Recent research papers It is generally acknowledged that respiratory rate counting is the most important vital sign to measure, however, it is also the vital sign that often is not measured or measured poorly. A selection of recent research papers are set out below: . Respiratory rate: the neglected vital sign. Cretikos 2008; " There is substantial evidence that an abnormal respiratory rate is predictor of potentially serious clinical events." . The recognition and early management of critical illness. Saxon 2005; " Critical illness is preceded by prodromal signs warning of impending physiological catastrophe. These simple physiological signs, the most sensitive of which is the respiratory rate, can be quantified using early warning scores." . Why don't nurses monitor the respiratory rate of patients? Hogan 2006; " Respiratory rate was identified as the one parameter which nursing staff recorded less than 50% of the time." . Caring for patients after mechanical ventilation. 2007; " When removed from ventilation . it is vital to measure respiratory rate frequently." . National confidential enquiry into patient outcome and death. NCEPOD 2005, ( a UK Department of Health- sponsored report); " The importance of respiratory rate monitoring should be highlighted. This parameter should be recorded at any point that other observations are being made" and " it should be emphasised that pulse oximetry does not replace respiratory rate monitoring." Development of the respiratory rate counter Anaxsys Technology Ltd ( Anaxsys) has developed a Respiratory Rate Counter ( R8) with a £ 230,000 Technology Strategy Board ( TSB) grant. The company was given another £ 100,000 under the government's Respiratory rate: Why neglecting this vital sign could cost lives " Breathing life into patient safety" by Dr. Deryk Williams of Anaxsys Technology Ltd About Anaxsys Technology Ltd Anaxsys Technology Ltd has developed novel patented sensors for the analysis of breath for which there are a range of potential applications, including respiratory rate monitoring, screening for lung cancer, diagnosis and management of asthma and COPD and the diagnosis of sleep apnoea. The technology involves measuring the moisture profile in exhaled breath and is protected by a strong intellectual property portfolio.
Community Health & Care Support 33 Anaxsys Technology Ltd PATIENT SAFETY MONITOR Small Business Research Initiative ( SBRI) scheme which has enabled Anaxsys to develop the same device for use in ambulances. The original idea came from an anaesthetist who suggested fitting a sensor into an oxygen mask. R8 is based on the process of checking whether someone is still breathing after an accident by holding a mirror in front of their mouth and seeing if any condensation is produced. The moisture from the patient's breath condenses on the sensor to produce a signal and the mask is connected via a cable to an electronic monitor which displays the current respiratory rate - as well as a graph of its movement in the last hour. A clinical trial is currently underway and will be finished by May 2010. This is a straightforward study comparing the Respiratory Rate Counter ( R8) with a nurse with a stop watch. CH& CS Contact For further information contact: Dr Deryk Williams Anaxsys Technology Ltd Unit 6, Send Business Centre, 3 Tannery House, Tannery Lane Send, Woking, GU23 7EF Tel: 01482 211011; Website: www. anaxsys. co. uk